Elementos determinantes de la gobernabilidad en la planeación participativa comunal y corregimental

The defective body sub-discourse contests the maternal age sub-discourse with

the argument that the reason for the "elderly" primipara's problems in labour are not her age but the "abnormal" structure of her reproductive system. In 1 929, Schulze (citing Meyer, 1 9 1 6) put forward the argument that within the "elderly" primiparas' group there were a significant number of women who " . . . would have had difficulty at any age but who marry late because of defmite physical defects or who conceive late because of hypoplasia of the genital organs" (p. 824). The condition "genital hypoplasia" was believed to complicate the labour process and was manifested by a tight perineum, difficult cervical dilatation and "ineffective" labour pains.

A second theory proposed (Schulze, 1 929, citing Jaroschka, 1 9 1 6) was that there were two types of women who were disposed to dystocia (difficult or prolonged labour): "the woman with marked obesity, sparse pubic hair, a short neck, short fat thighs and large breasts with little parenchyma; and an aesthenic type with delicate bones , pale coloring, poor nutrition and poorly developed body musculature" (p. 828). Evident in the typology was the idealisation of a body type that fell between these two extremes and which was optimal for childbirth. Obese and aesthenic women had ineffective labour pains and consequently could not birth their babies without assistance. Schulze proposed that women's physical type be documented in their obstetric records. Thus women's body type had sufficient significance for Schulze to suggest it to be a predictive indicator of prolonged labour requiring intervention.

Implicit in Schulze's ( 1 929) statements is the belief that the structure of a woman's body is an important key to her marriageability as well as her ability to conceive and labour without assistance. The two theories assume that a woman with any congenital physical defects is incapable of bearing and birthing a child normally.

Women with defective bodies were not intended to have children. As Tew et al (1938) stated, "We believe their behaviour in pregnancy and parturition is influenced by certain constitutional factors as well as some stigmata of genital hypoplasia, and these patients would probably not be ideal obstetric material subject matter at any age" (p. 779).

Although Schulze's ( 1929) motive for identifying women who have physical or reproductive defects is to challenge the validity of maternal age as both a cause and a predictive indicator, for women categorised as obese, aesthenic or late "conceivers", the result is that they are situated in the realm of abnormal and problematic. Spallone ( 1989) identifies dysfunctional and disabled reproduction as falling under the medical domain. Such women automatically require medical technology to assist them if they are to conceive and give birth.

Later American obstetricians (Arthur & Kaltreider, 1 956; Daichman, 1932; Tew

et aI, 1 938), drawing on retrospective analyses of their local hospital records of "elderly primiparas", pursued Schulze's ( 1 929) hypothesis that women who had difficulty in conceiving also had difficulty in birthing. The two later studies compared "elderly primiparas" to the total clinic popUlation, whereas Daichman ( 1 932) only reviewed the "elderly" primiparas' figures. While Daichman ( 1 932) and Tew et al (1 938) found evidence to support their hypothesis, Arthur and Kaltreider (1 956) did not fmd any difference between the two groups. The variable of infertility was determined by the number of years between marriage and conception. For Arthur and Kaltreider, if a woman had not become pregnant within five or more years of marriage, she was placed in the "infertile" group. The assumption on which the grouping was based was that pregnancy is inevitable and normal in the first five years of marriage. Moscucci (1 990) writes that early twentieth century gynaecologists saw women as existing totally for sexual functions, mentally and physically. There was no apparent recognition that women may have chosen to defer childbearing, and no consideration that women may also have had the capacity to control their fertility through contraceptive methods.

The defective body sub-discourse does not surface again in the "elderly primipara" literature for another 30 years. Barken and Bracken (1 987) argued that in comparison to the past women were now "actively" choosing to delay childbirth and did not have the same history of infertility. To show that maternal age was not a predictor of preterm delivery and low birth weight, they compared the birth weights and preterm births of four groups of primiparas. There were two groups of younger primiparas (one group who had a history of infertility or spontaneous abortion and a second group of

those who did not) and two similar groups of "older" primiparas. Generally they found that "older" age did not significantly increase the risk of preterm delivery or low birth weight. The group of women aged 30 or over who had a history of miscarriages or infertility had a higher rate of preterm births and low birth weights than the younger women who did not have such history. The group of "older" women with no history of miscarriage or infertility had similar rates of preterm delivery and low birth weight as the same group of younger women. They suggested on the basis of their fmdings that some of the increased risk found in "elderly" primiparas may be attributable to a history of "reproductive problems".

Studies by Tuck, Yudkin and Turnbull ( 1 988) and Cnattingius, et al ( 1 992) demonstrate the continued contest between the maternal age and the defective body sub­ discourses. Cnattingius et al (1 992) analysed the relationship between infertility and late fetal and early neonatal deaths. They found that women who had been infertile for more than three years had higher, but not statistically significant, rates of late fetal and early neonatal deaths. The incidence of infertility was more common in the "elderly" than in the younger primiparas. Overall, they found that maternal age increased the risk of low birth weight, preterm delivery and small for gestational age babies. However, the relationship between infertility and low birth weight and preterm delivery was not examined.

Although these sub-discourses contest and contradict one another as to the causes of fetal and neonatal problems, the object of their gaze remains the "elderly" primipara. Whether the cause is her infertility or her age, the problem is her body.